# Frontline nurses’ adherence to COVID-19 policies in care delivery at a Johannesburg Academic Hospital

## TL;DR

This study examines how well frontline nurses in a Johannesburg hospital followed COVID-19 policies and finds gaps in adherence that could increase infection risks.

## Contribution

The study introduces a three-phase approach to assess policy adequacy and adherence, revealing specific areas needing improvement in nursing practices.

## Key findings

- Nurses showed higher adherence during direct patient contact compared to pre- and post-contact behaviors.
- Policies from NICD, DoH, and the hospital were fully adequate, while CDC and NIH policies were 82% adequate.
- Adherence was strongly correlated with general precautionary measures (r = 0.903).

## Abstract

Nurses’ adherence to coronavirus disease 2019 (COVID-19) policies significantly impacts infection rates, yet various factors, including communication gaps, lack of policy involvement and insufficient training, hinder compliance.

This study investigated the availability of COVID-19 infection control policies and frontline nurses’ adherence to these policies at an academic hospital in Johannesburg.

A quantitative, descriptive-comparative design was employed, using stratified random sampling across three phases: policy document analysis, adherence assessment and observation. Phase one evaluated the comprehensiveness of policies from National Institute for Communicable Diseases (NICD), Department of Health (DoH) (SA), National Institutes of Health (NIH) and Centers ffor Disease Control and Prevention (CDC).

National Institute for Communicable Diseases, DoH and academic hospital policies were 100% adequate, while CDC and NIH policies met 82% of assessed attributes. Phases two and three assessed adherence using questionnaires and observations. Results revealed higher adherence during direct patient contact (median 5/7; 70%) compared to pre- and post-contact behaviours (median 3/6; 50%). Principal component analysis showed a strong correlation (r = 0.903) between adherence and general precautionary measures.

Despite partial compliance, findings highlight a need for enhanced in-service training and improved communication strategies to promote policy adherence and minimise infection risks.

Recommendations are provided to strengthen nursing practice, education and policy development, empowering nurses with knowledge and strategies for effective infection control.